哌甲酯控释剂治疗对注意缺陷多动障碍儿童父母压力的影响

Effects of methylphenidate treatment on parenting stress in children with attention deficit hyperactivity disorder

目的：探讨哌甲酯控释剂（OROS—MPH）治疗对注意缺陷多动障碍（attention deficit hyperactivity disorder，ADHD）患者临床症状和父母压力的影响。方法：采用自身对照研究设计，对符合美国精神障碍诊断与统计手册第四版（Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition，DSM—IV）诊断标准的73名ADHD患者（年龄6～15岁），使用哌甲酯控释剂（18—54mg／d）治疗8周。以父母填写的IOWA Conners量表及研究者填写的ADHD症状评定问卷评估患者的临床症状，并作为主要临床疗效评价指标，以父母填写的父母压力指数量表（Parenting Stress Index，PSI）来评估父母的压力，分别在基线、治疗4周末和8周末用以上问卷进行评估。结果：66名ADHD患儿完成了8周的治疗。经哌甲酯控释剂治疗后，ADHD患者IOWA Conners量表中的注意缺陷／多动因子分、对立／违抗因子分和总分随治疗时间下降（均P〈0．001）；ADHD症状评定问卷的注意缺陷因子分、多动冲动因子分和总分较服药前下降（均P〈0．001）；PSI量表的压力总分随时间明显下降（P〈0．01），PSI量表中儿童方面分量表中，适应性、父母的接受度、要求、心境、注意不能／多动、父母的强制性6个因子得分均随着时间下降（均P〈0．01）；在父母方面分量表中，抑郁、角色的限制、配偶关系、孤独、健康状况5个因子得分均随着时间显著下降（均P〈0．01）。基线时PSI总分与IOWA Conners量表总分、ADHD症状评定问卷总分呈正相关（r=0．346～0．902，均P〈0．01）。结论：哌甲酯控释剂治疗能有效改善ADHD患者的临床症状和改善患者及其父母的压力，提高社会功能。

Objectives： To assess the effectiveness of OROS methylphenidate on clinical improvements in children with ADHD and to examine the effect on parenting stress in ADHD. Methods： In this self-control study, 73 children with ADHD ranged from 6 - 15 years were treated with OROS methylphenidate （ 18 - 54 mg/d） for 8 weeks. ADHD symptoms were assessed with the IOWA Conners questionnaire by parents, with ADHD-IV rating scale by researchers at baseline, the end of 4th week and the end of 8th week after treatment. All parents completed the Parenting Stress Index （PSI）, which consists of child domain and parent domain subscales. Results： Totally 66 children with ADHD completed 8 week medication. The total scores of IOWA Conners rating scale[（20. 2 ±6.4）, （ 12. 3 ± 6. 0）, （9. 6± 4. 8） ], inattention/hyperactive subscale [ （ 11.0 ±2. 3 ）, （6. 9 ±3. 2 ）, （5. 3± 2. 6） ], opposi- tional/defiant subscale[ （9. 2 ± 5.2）, （ 5.4 ±3.5）, （4. 4 ± 2.6） ] were significantly decreased after the treatment （ Ps 〈 0. 01 ）. The total scores of ADHD-IV rating scale[ （ 35.6±7. 8 ）, （ 18.1± 9. 4）, （ 14. 9±7. 5） ] inattentive factor [ （21.2 ±3.5）, （ 11.3± 5.2）, （ 9. 8± 4. 5 ） ], hyperactive/impulsive factor [ （ 14. 4± 5. 9）, （ 6. 7 ± 4. 6）, （ 5. 1 ± 3.6）] were significantly decreased after the treatment（Ps 〈0. 01）. The total scores of PSI [（310. 8 ±37.7）（291.6± 36. 1）, （283. 1±42.5） ] Parenting Domain subscale [ （ 161.9 ± 23. 3）, （ 156. 1 ± 20. 8）, （ 153. 2 ± 22. 3） ] and Child Domain subscale[ （ 147. 6 ± 18.3）, （ 135.3 ± 19. 7）, （ 130. 2 ± 23.4） ] were significantly decreased after treatment （Ps 〈0. 01）. The PSI Total Stress scores were significantly positive correlated with the scores of IOWA Conners rating scale and the scores of ADHD-IV rating scale at baseline （r =0. 35-0.90, P 〈0. 01）. Condusion： The results suggest the OROS methylphenidate not only have significant clinical effectiveness, but also can reduce parenting stress and improve the social function of children with ADHD.